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Privacy Policy

NOTICE OF PRIVACY PRACTICES

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

  • How we may use and disclose your IIHI
  • Your privacy rights in your IIHI
  • Our obligations concerning the use and disclosure of your IIHI

The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. FOR ALL CONCERNS REGARDING THIS NOTICE, PLEASE CONTACT:

Beata George
34975 N. North Valley Parkway
Bldg. 6, Suite 138
Phoenix, Arizona 85086

C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your IIHI.

1. Treatment. Our practice may use your IIHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your IIHI in order to write a prescription for you, or we might disclose your IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice – including, but not limited to, our doctors and nurses – may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children or parents.

2. Payment. Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your IIHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you directly for services and items.

3. Health Care Operations. Our practice may use and disclose your IIHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your IIHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.

Appointment Reminders. Our practice may use and disclose your IIHI to contact you and remind you of an appointment.

Treatment Options. Our practice may use and disclose your IIHI to inform you of potential treatment options or alternatives.

Health-Related Benefits and Services. Our practice may use and disclose your IIHI to inform you of health-related benefits or services that may be of interest to you.

Release of Information to Family/Friends. Our practice may release your IIHI to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information.

4. Disclosures Required By Law. Our practice will use and disclose your IIHI when we are required to do so by federal, state or local law.

D. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

1. Public Health Risks. Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:

  • maintaining vital records, such as births and deaths
  • reporting child abuse or neglect
  • preventing or controlling disease, injury or disability
  • notifying a person regarding potential exposure to a communicable disease
  • notifying a person regarding a potential risk for spreading or contracting a disease or condition
  • reporting reactions to drugs or problems with products or devices
  • notifying individuals if a product or device they may be using has been recalled
  • notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
  • notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2. Health Oversight Activities. Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3. Lawsuits and Similar Proceedings. Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4. Law Enforcement. We may release IIHI if asked to do so by a law enforcement official:

  • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
  • Concerning a death we believe has resulted from criminal conduct
  • Regarding criminal conduct at our offices
  • In response to a warrant, summons, court order, subpoena or similar legal process
  • To identify/locate a suspect, material witness, fugitive or missing person
  • In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

5. Deceased Patients. Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.

6. Organ and Tissue Donation. Our practice may release your IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

7. Research. Our practice may use and disclose your IIHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your IIHI for research purposes except when: (a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board; (b) we obtain the oral or written agreement of a researcher that (i) the information being sought is necessary for the research study; (ii) the use or disclosure of your IIHI is being used only for the research and (iii) the researcher will not remove any of your IIHI from our practice; or (c) the IIHI sought by the researcher only relates to decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the IIHI of the decedents.

8. Serious Threats to Health or Safety. Our practice may use and disclose your IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

9. Military. Our practice may disclose your IIHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

10. National Security. Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your IIHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

11. Inmates. Our practice may disclose your IIHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

12. Workers’ Compensation. Our practice may release your IIHI for workers’ compensation and similar programs.

E. YOUR RIGHTS REGARDING YOUR IIHI

You have the following rights regarding the IIHI that we maintain about you:

1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to [insert name, or title, and telephone number of a person or office to contact for further information] specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your IIHI, you must make your request in writing. Your request must describe in a clear and concise fashion: a) the information you wish restricted; (b) whether you are requesting to limit our practice’s use, disclosure or both; and (c) to whom you want the limits to apply.

3. Inspection and Copies. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical records and billing records. You must submit your request in writing in order to inspect and/or obtain a copy of your IIHI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the IIHI kept by or for the practice; (c) not part of the IIHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created the information is not available to amend the information.

5. Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your IIHI for non-treatment or operations purposes. Use of your IIHI as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time.

7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, please contact us directly. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization. Please note, we are required to retain records of your care.

It is the policy of our practice that all physicians and staff preserve the integrity and the confidentiality of protected health information (PHI) pertaining to our patients. The purpose of this policy is to ensure that our practice and its physicians and staff have the necessary medical and PHI to provide the highest quality medical care possible while protecting the confidentiality of the PHI of our patients to the highest degree possible. Patients should not fear about providing information to our practice and its physicians and staff for purposes of treatment, payment and healthcare operations (TPO). To that end, our practice and its physicians and staff will:

  • Adhere to the standards set forth in the Notice of Privacy Practices. Collect, use and disclose PHI only in conformance with state and federal laws and current patient covenants and/or authorizations, as appropriate. Our practice and its physicians and staff will not use or disclose PHI for uses outside of practice’s TPO, such as marketing, employment, life insurance applications, etc. without an authorization from the patient.
  • Use and disclose PHI to remind patients of their appointments only within their consent.
  • Recognize that PHI collected about patients must be accurate, timely, complete, and available when needed. Our practice and its physicians and staff will: Implement reasonable measures to protect the integrity of all PHI maintained about patients.
  • Recognize that patients have a right to privacy. Our practice and its physicians and staff respect the patient’s individual dignity at all times. Our practice and its physicians and staff will respect patient’s privacy to the extent consistent with providing the highest quality medical care possible and with the efficient administration of the facility.
  • Act as responsible information stewards and treat all PHI as sensitive and confidential. Consequently, our practice and its physicians and staff will: Treat all PHI data as confidential in accordance with professional ethics, accreditation standards, and legal requirements. Not disclose PHI data unless the patient (or his or her authorized representative) has properly consented to or authorized the release or the release is otherwise authorized by law.
  • Recognize that, although our practice “owns” the medical record, the patient has a right to inspect and obtain a copy of his/her PHI. In addition, patients have a right to request an amendment to his/her medical record if he/she believes his/her information is inaccurate or incomplete. Our practice and its physicians and staff will:
  • Permit patients access to their medical records when their written requests are approved by our practice. If we deny their request, then we must inform the patients that they may request a review of our denial. In such cases, we will have an on-site healthcare professional review the patients’ appeals.
  • Provide patients an opportunity to request the correction of inaccurate or incomplete PHI in their medical records in accordance with the law and professional standards.

All physicians and staff of our practice will maintain a list of all disclosures of PHI for purposes other than TPO for each patient. We will provide this list to patients upon request, so long as their requests are in writing. All physicians and staff of our practice will adhere to any restrictions concerning the use or disclosure of PHI that patients have requested and have been approved by our practice. All physicians and staff of our practice must adhere to this policy. Our practice will not tolerate violations of this policy. Violation of this policy is grounds for disciplinary action, up to and including termination of employment and criminal or professional sanctions in accordance with our practice’s personnel rules and regulations.

Our practice may change this privacy policy in the future. Any changes will be effective upon the release of a revised privacy policy and will be made available to patients upon request.

Privacy Policy: Our practice recognizes and respects the fact that the patient has a right to inspect and obtain a copy of his/her Protected Health Information (PHI).

MEDICAL RECORDS PROTOCOL

“Medical records” means all communications related to a patient’s physical or mental health or condition that are recorded in any form or medium and that are maintained for purposes of patient diagnosis or treatment, including medical records that are prepared by a health care provider or by other providers. Medical records do not include materials that are prepared in connection with utilization review, peer review or quality assurance activities, including records that a health care provider prepares pursuant to these. Medical records do not include recorded telephone and radio calls to and from a publicly operated emergency dispatch office relating to requests for emergency services or reports of suspected criminal activity, but shall include communications that are recorded in any form or medium between emergency medical personnel and medical personnel concerning the diagnosis or treatment of a person. “Payment records” means all communications related to payment for a patient’s health care that contain individually identifiable information. “Source data” means information that is summarized, interpreted or reported in the medical record, including x-rays and other diagnostic images.

Unless otherwise provided by law, all medical records and payment records, and the information contained in medical records and payment records, are privileged and confidential. This office may only disclose that part or all of a patient’s medical records and payment records as authorized by state or federal law or written authorization signed by the patient or the patient’s health care decision maker.

On the written request of a patient or the patient’s health care decision maker for access to or copies of the patient’s medical records and payment records, this office shall provide access to or copies of the records to the patient or the patient’s health care decision maker.

This office may deny a request for access to or copies of medical records or payment records if it is determined that either:

  1. Access by the patient or the patient’s health care decision maker is reasonably likely to endanger the life or physical safety of the patient or another person.
  2. The records make reference to a person other than a health professional and access by the patient or the patient’s health care decision maker is reasonably likely to cause substantial harm to that other person.
  3. Access by the patient’s health care decision maker is reasonably likely to cause substantial harm to the patient or another person.
  4. Access by the patient or the patient’s health care decision maker would reveal information obtained under a promise of confidentiality with someone other than a health professional and access would be reasonably likely to reveal the source of the information.
  5. The information was created or obtained in the course of clinical research and the patient or the patient’s health care decision maker agreed to the denial of access when consenting to participate in the research and was informed that the right of access will be reinstated on completion of the research.
  6. A health care provider is a correctional institution or is acting under the direction of a correctional institution and access by a patient who is an inmate in the correctional institution would jeopardize the health, safety, security, custody or rehabilitation of the patient or other inmates or the safety of any officer, employee or other person at the correctional institution or of a person who is responsible for transporting the inmate.

If this office denies a request for access to or copies of the medical records or payment records, this office must note this determination in the patient’s records and provide to the patient or the patient’s health care decision maker a written explanation of the reason for the denial of access. This office must release the medical records or payment records information for which there is not a basis to deny access under this section.

This office shall disclose medical records or payment records, or the information contained in medical records or payment records, without the patient’s written authorization as otherwise required by law or when ordered by a court or tribunal of competent jurisdiction.

This office may disclose medical records or payment records, or the information contained in medical records or payment records, pursuant to written authorization signed by the patient or the patient’s health care decision maker.

This office may disclose medical records or payment records or the information contained in medical records or payment records without the written authorization of the patient or the patient’s health care decision maker as otherwise authorized by state or federal law, including the health insurance portability and accountability act privacy standards (45 Code of Federal Regulations part 160 and part 164, subpart E), or as follows:

  1. To health care providers who are currently providing health care to the patient for the purpose of diagnosis or treatment of the patient.
  2. To health care providers who have previously provided treatment to the patient, to the extent that the records pertain to the provided treatment.
  3. To ambulance attendants as defined in section 36-2201 for the purpose of providing care to or transferring the patient whose records are requested.
  4. To a private agency that accredits health care providers and with whom the health care provider has an agreement requiring the agency to protect the confidentiality of patient information.
  5. To a health profession regulatory board as defined in section 32-3201.
  6. To health care providers for the purpose of conducting utilization review, peer review and quality assurance pursuant to section 36-441, 36-445, 36-2402 or 36-2917.
  7. To a person or entity that provides billing, claims management, medical data processing, utilization review or other administrative services to the patient’s health care providers and with whom the health care provider has an agreement requiring the person or entity to protect the confidentiality of patient information.
  8. To the legal representative of a health care provider in possession of the medical records or payment records for the purpose of securing legal advice.
  9. To the patient’s third party payor or the payor’s contractor.
  10. To the industrial commission of Arizona or parties to an industrial commission claim pursuant to title 23, chapter 6.

This office may disclose a deceased patient’s medical records or payment records or the information contained in medical records or payment records to the patient’s health care decision maker at the time of the patient’s death. This office may disclose a deceased patient’s medical records or payment records or the information contained in medical records or payment records to the personal representative or administrator of the estate of a deceased patient, or if a personal representative or administrator has not been appointed, to the following persons in the following order of priority, unless the deceased patient during the deceased patient’s lifetime or a person in a higher order of priority has notified the health care provider in writing that the deceased patient opposed the release of the medical records or payment records:

  1. The deceased patient’s spouse, unless the patient and the patient’s spouse were legally separated at the time of the patient’s death.
  2. The acting trustee of a trust created by the deceased patient either alone or with the deceased patient’s spouse if the trust was a revocable inter vivos trust during the deceased patient’s lifetime and the deceased patient was a beneficiary of the trust during the deceased patient’s lifetime.
  3. An adult child of the deceased patient.
  4. A parent of the deceased patient.
  5. An adult brother or sister of the deceased patient.
  6. A guardian or conservator of the deceased patient at the time of the patient’s death.

This office shall release medical records or payment records to third parties pursuant to subpoena if:

A. A subpoena seeking medical records or payment records is served on the this office at least ten days before the production date on the subpoena.

B. A subpoena that seeks medical records or payment records meets one of the following requirements:

  1. The subpoena is accompanied by a written authorization signed by the patient or the patient’s health care decision maker.
  2. The subpoena is accompanied by a court or tribunal order that requires the release of the records to the party seeking the records or that meets the requirements for a qualified protective order under the health insurance portability and accountability act privacy standards (42 Code of Federal Regulations section 164.512(e)).
  3. The subpoena is a grand jury subpoena issued in a criminal investigation.
  4. The subpoena is issued by a health profession regulatory board as defined in section 32-3201.
  5. This office is required by another law to release the records to the party seeking the records.

C. If a subpoena does not meet one of the requirements of subsection B of this section, this office shall not produce the medical records or payment records to the party seeking the records, but may either file the records under seal, object to production or file a motion to quash or modify the subpoena. It is sufficient compliance with a subpoena issued in a court or tribunal proceeding if this office delivers the medical records or payment records under seal as follows:

  1. This office may deliver by certified mail or in person a copy of all the records described in the subpoena by the production date to the clerk of the court or tribunal or if there is no clerk then to the court or tribunal, together with the affidavit.
  2. This office shall separately enclose and seal a copy of the records in an inner envelope or wrapper, with the title and number of the action, name of the health care provider and date of the subpoena clearly inscribed on the copy of the records. This office shall enclose the sealed envelope or wrapper in an outer envelope or wrapper that is sealed and directed to the clerk of the court or tribunal or of there is no clerk then to the court or tribunal.
  3. The copy of the records shall remain sealed and shall be opened only on order of the court or tribunal conducting the proceeding.
  4. The records shall be accompanied by the affidavit of the custodian or other qualified witness, stating in substance each of the following:

a. That the affiant is the duly authorized custodian of the records and has authority to certify the records.

b. That the copy is a true complete copy of the records described in the subpoena.

c. If applicable, that this office is subject to the confidentiality requirements in 42 United States code sections 290dd-3 and 290ee-3 and applicable regulations and that those confidentiality requirements may apply to the requested records. The affidavit shall request that the court make a determination, if required under applicable federal law and regulations, as to the confidentiality of the records submitted.

d. If applicable, that this office has none of the records described or only part of the records described in the subpoena.

The copy of the records is admissible in evidence as provided under rule 902(11), Arizona rules of evidence. The affidavit is admissible as evidence of the matters stated in the affidavit and the matters stated are presumed true. If more than one person has knowledge of the facts, more than one affidavit may be made. The presumption established by this paragraph is a presumption affecting the burden of producing evidence.

If a subpoena does not meet one of the requirements of subsection B of this section or if grounds for objection exist under rule 45 of the Arizona Rules of Civil Procedure, this office may file with the court or tribunal an objection to the inspection or copying of any or all of the records as follows:

  1. On filing an objection, this office shall send a copy of the objection to the patient at the patient’s last known address, to the patient’s attorney if known and to the party seeking the records, unless after reasonable inquiry the health care provider cannot determine the last known address of the patient.
  2. On filing the objection, this office has no further obligation to assert a state or federal privilege pertaining to the records or to appear or respond to a motion to compel production of records, and may produce the records if ordered by a court or tribunal. If an objection is filed, the patient or the patient’s attorney is responsible for asserting or waiving any state or federal privilege that pertains to the records.
  3. If an objection is filed, the party seeking production may request an order compelling production of the records. If the court or tribunal issues an order compelling production, a copy of the order shall be provided to the health care provider. On receipt of the order, the health care provider shall produce the records.
  4. If applicable, an objection shall state that this office is subject to the confidentiality requirements in 42 United States code sections 290(dd)(3) and 290(ee)(3), shall state that the records may be subject to those confidentiality requirements and shall request that the court make a determination, if required under the applicable federal law and regulations, on whether the submitted records are subject to discovery.

If a party seeking medical records or payment records wishes to examine the original records maintained by this office, the health care provider may permit the party to examine the original records if the subpoena meets one of the requirements of this section. The party seeking the records also may petition a court or tribunal for an order directing this office to allow the party to examine the original records or to file the original records under seal with the court or tribunal.

FEES

A. Except as otherwise provided by law, this office may charge a person who requests copies of medical records or payment records a reasonable fee for the production of the records. Except as necessary for continuity of care, this office may require the payment of any fees in advance.

B. This office shall not charge for the pertinent information contained in medical records provided to:

  1. Another health care provider for the purpose of providing continuing care to the patient to whom the medical record pertains.
  2. The patient to whom the medical record pertains for the demonstrated purpose of obtaining health care.
  3. The health care decision maker of the patient to whom the medical record pertains for the demonstrated purpose of obtaining health care for the patient.
  4. Medical boards or an officer of the department of health services or the local health department requesting records.

When the patient’s request to copy his/her records has been accepted, the office may charge a fee of $.35 cents per page, with the exceptions noted above, payable in advance of coping This office shall retain the original or copies of a patient’s medical records as follows:

  1. If the patient is an adult, for at least six years after the last date the adult patient received medical or health care services.
  2. If the patient is a child, either for at least three years after the child’s eighteenth birthday or for at least six years after the last date the child received medical or health care services from that provider, whichever date occurs later.
  3. Source data may be maintained separately from the medical record and must be retained for six years from the date of collection of the source data.
  4. This office may dispose of unclaimed medical records after the required period of time to retain them has expired and after this office has made good faith efforts to contact the patient.
  5. When this office closes or sells the practice the office shall take reasonable measures to ensure that the provider’s records are retained pursuant to this section. Patients shall be notified in writing with instructions of where and how to obtain their records prior to the office closing.
  6. This office shall timely respond to requests from patients for copies of their medical records or to access their medical records.

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EuroMed Foundation

34975 North North Valley Parkway,
Building 6, # 138
Phoenix, AZ 85086

Phone: (602) 404-0400
Fax: (602) 404-0403

Monday–Friday: 8 a.m.–5 p.m.

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